Provider Demographics
NPI:1003412347
Name:SATO, NIMIKO
Entity type:Individual
Prefix:
First Name:NIMIKO
Middle Name:
Last Name:SATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIMIKO
Other - Middle Name:OWAKI
Other - Last Name:LOGRASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 E 3RD ST STE G106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1493
Mailing Address - Country:US
Mailing Address - Phone:213-473-0305
Mailing Address - Fax:
Practice Address - Street 1:231 E 3RD ST STE G106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1493
Practice Address - Country:US
Practice Address - Phone:213-473-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health